Kinematic alignment is a new technique for performing total knee replacement. Currently over one million total knees are performed globally on an annual basis. Despite enormous advances in materials and technology, approximately 20% of knees have less than optimal outcome. The primary technical approach for knee replacement and for alignment of components is based on the theories proposed by John Insall in the 1970's and 1980s. This technique is based on creating mechanical alignment of the joint by “correcting” the joint line from an average 3 degrees of varus alignment relative to the tibial axis to a neutral (or perpendicular) alignment between the tibia and the tibial cut. The technique mandates creating asymmetric resection cuts of the femur and tibia to reorient the joint line and create equal flexion and extension gaps between the resected surfaces. The implants/components that are seated onto these bone cuts are thus forced to rotate around a non-anatomic axis. This creates soft tissue imbalance throughout the arc of motion that necessitates a series of soft tissue/ligament releases designed to re-establish balance in flexion and extension.
What is needed are newer techniques for performing total knee replacement that preserve the joint line of the pre-arthritic knee by creating symmetric resection cuts from the boney surfaces of the femur and tibia equal geometrically to the size of the implants to be used for reconstruction.